Ophthalmic Medications Flashcards
Opthalmic Drug Key Factors
- effectiveness
- toxicity
- propensity to cause allergic reactions
- availability in ointment or solution form
- cost
Drug Classes
Antibiotics
Antivirals
Corticosteroids
Antibiotic Corticosteroid combinations
NSAIDs
Allergy Medications
Cycloplegics
Lubricants
Vitamin Supplements
Ophthalmic Antibiotics (classes)
Aminoglycosides
Fluoroquinolones
Miscellaneous
Ointments
Aminoglycosides
i.e. Tobramycin (Tobrex) - least expensive and less ocular toxicity
MOA: inhibits bacterial protein synthesis
Uses
- powerful G- and some synergism against G+
Adverse Effects
- superficial punctate keratitis (SPK)
- localized ocular toxicity and hypersensitivity - conjunctival erythema, lid itching/swelling
Less expensive than fluoroquinolones
Alternatives for bacterial conjunctivitis, but incomplete G+ coverage
Fluoroquinolones
MOA: inhibits bacterial DNA gyrase
Uses: braoder spectrum of activity - BIG GUNS!
- corneal infections/ulcers
- severe conjunctivitis
**Adverse effects: **
- white crystalline ppts, lid margin crusting, crystals/scales, FB sensation, conjunctival hyperemia, corneal staining, photophobia, nausea
- Not used first line for conjunctivitis due to poor Strep coverage, expense and resistance concern. *
**Products: **
- 2nd Generation: Ciprofloxacin, ofloxacin
- 3rd Generation: Levofloxacin
- 4th Generation: Moxifloxacin, Besifloxacin
Trimethoprim + Polymyxin B
Polytrim
MOA: inhibits folic acid synthesis
Uses: G+, G-; especially effective agaist **H. flu and S. pneumo **
AE: **low toxicity **
Cost effective, first line treatment for conjunctivitis
Good for kids
Antibiotic Ointments
**Ciprofloxacin **
- *Erythromycin **
- MOA: inhibits bacterial protein synthesis
- very gentle on cornea, inexpensive
- **first line treatment for conjunctivitis **
- *Bacitracin **
- MOA: inhibits cell wall synthesis
- use for treatment of blepharitis
- avoid long term use
- **when combined with Polymyxin B is first line tx for conjunctivitis **
Antivirals
**Topical option: **
- Trifluridine - use for serious infections like *dendritic HSV keratitis *
- Vidarabine - use if intolerance of trifluridine
**Oral **
- **Acyclovir **
- Valacyclovir and Famciclovir - more expensive but less frequent dosing
- As effective as topicals on corneal epithelial
- start therapy within 72 hrs
- effectives against **HSV and Varicella Zoster **
Corticosteroids
Products
- Prednisolone acetate - gold standard (acetate forms penetrate better than alcohol forms)
- Rimexolone, prednisolone sodium phosphate, loteprednol etabonate other options with potentially fewer IOP complications
Adverse Effects
- **cataracts, elevated IOP **
- optic nerve damage, papilledema, pseudomotor cerebri
- can mask infection –> superinfections of the eye
**IOP Monitoring **
- Baseline
- Q week until therapy is stopped
- Taper corticosteroid if duration of therapy is prolonged
Antibiotic-Corticosteroid Combinations
Dexamethasone/Tobramycin - Tobradex
Dramatically reduces redness and inflammation
NSAIDs
MOA: reduces prostaglandin production via cyclo-oxygenase inhibition
Products: Ketorolac or Diclofenac
Uses: tx eye pain or itching; post-op/post-FB
AE: transient burnign and stinging upon instillation; minor occular irritation
Allergic Conjunctivitis Tx
Steps:
- Removal and avoidance of allergen
- Artificial tears solution to remove allergen
- Topical antihistamine or antihistamine/decongestant combination (decongestant use limited to <10days; consider PO if systemic symptoms are present)
- Mast cell stabilizer like Cromolyn (full response may take 4-6 weeks) or MCS/antihistamine combo like Olopatadine
- Trial of topical NSAID - ketorolac
- Short term topical corticosteroids and immunotherapy
Cycloplegics
MOA: anticholinergic agents block the responses of the sphincter muscle of the iris and ciliary body to cholinergic stimulation, producing pupillary dilation (mydriasis) and paralysis of accomodation (cycloplegia)
Products:
- Atropine - longest half life
- Homatropine
- Cyclopentolate
- Tropicamide - shortest half life
Use: for reduction of inflammation and pain - like putting cast on your eye
AE: increased IOP, transient stinging/burning, irritation with prlonged use + some others
Note: all cycloplegics have red caps
Lubricants
Variables:
- unit dose vs. multi-dose
- viscosity - drop vs. gel vs. ointment - Genteal, Thera Tears, Systane
Alternatives:
- punctal plugs
- cyclosporine (Restasis)
Vitamin Supplements
- Lutein - found in yellow foods, helps maintain eye health
- AREDS - includes: Vit A, C, E, Zn, Cu - slows rate of progression of age related macular degeneration
